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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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muscle pain and tests
Nov 24, 2001


I have had HIV since 1983 and AIDS since 1995. I am on my 3rd drug combination, which includes Viracept, Kaletra, and ddi. The first combination of d4t and 3TC was discontinued due to viral resistance. The second, of Combivir, Ziagen and Viracept, was discontinued due to multiple side effects including "all over" muscle pain.

Now I have severe pain in my butt and thigh muscles, making it impossible to sit for any length of time. I also have neuropathy, making it painful to stand. And I have pain in my lower back (spine? maybe). Massaging my muscles eases the pain, which resumes immediately upon stopping the massage.

My viral load is undetectable, and my T-cells are probably around 150-200, the highest they've been since I discovered I had AIDS, in 1995.

From reading questions here, I understand I should get a CK test. However, the other tests terrify me. My question is, can you tell me which are the most important, and is there any way to alleviate the pain of diagnostic tests used to determine the cause of pain?

Is there any way to be "knocked out" before a spinal tap? I've had a huge phobia about this test since I was a child, and I have heard many horror stories about it since.

Also, what does a muscle biopsy involve? My muscles already hurt, taking a chunk out of them doesn't sound too appealing.

I do hope you won't tell me to just grin and bear it. I've been grinning and bearing for a long time.

Thanks very much for any encouragement.

Response from Dr. Boyle

The symptoms you describe could be due to many different conditions, including those that involve muscle and/or nerve injury. If, however, the pain is only localized to the areas you describe, I think that it is more likely to be neurologic in origin. This may be related to the medications you are or have been on (including neuropathy related to d4T or ddI), or it may be related to to a peripheral (a nerve conduction study may help) or central process (and therefore an MRI of you lower spine may be helpful too). I am not sure that a muscle biopsy or a lumbar puncture is going to help, especially given your current CD4+ T cell count, unless you're having other symptoms that you didn't mention. If your doctor feels those are necessary there are ways to give you some sedation and pain relief so that they are not very painful. After the evaluation is completed, you may benefit from some adjunctive therapies, including physical therapy.

erythema nodosum and feet pain

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